Cost-effectiveness Of Cochlear Implantation Research Articles

Cochlear implant cost analysis in adults: a European narrative review.

The aim of this study was to provide an updated European narrative review spanning the last decade, focusing on the cost-effectiveness of cochlear implants (CIs) for adults with severe to profound post-lingual hearing loss. This review encompasses both prospective and retrospective approaches, as well as cross-sectional and longitudinal trials conducted on CIs in adults. All studies related to European countries (Austria, Germany, Switzerland, the Netherlands, Sweden, the UK and Poland) were conducted in English and were published between 2012 and June 2023. Nine studies were included in the analysis. The patients' ages ranged from 18years to over 67years, with sample sizes ranging from 20 to 100 patients; two of these studies were focused on single-sided deafness in adults. The Markov model was identified as the most commonly utilized analysis method. This review identified a general consensus on CI cost-effectiveness, despite substantial variability among countries in factors such as observation time horizons, cost-effectiveness thresholds, methods of cost collection, discount rates, CI eligibility criteria and country-specific health systems. Generally, CIs yield positive societal benefits for working-age individuals, potentially less for seniors. Early unilateral CI enhances cost-effectiveness, highlighting the importance of prompt candidate identification. A consistent undersupply of CIs relative to the percentage of potential recipients emerged across countries. Therefore, further investigation into subcategories such as single-sided deafness is warranted, along with country-specific cost analyses. Emphasizing the significance of detailed information on health systems and associated costs and benefits is crucial for facilitating comparisons across different settings.

The cost-effectiveness of Cochlear implants in Swedish adults

BackgroundResearch has shown unilateral cochlear implants (CIs) significantly improve clinical outcomes and quality of life in adults. However, only 13% of eligible Swedish adults currently use a unilateral CI. The objective was to estimate the cost-effectiveness of unilateral CIs compared to a hearing aid for Swedish adults with severe to profound hearing loss.MethodsA Markov model with a lifetime horizon and six-month cycle length was developed to estimate the benefits and costs of unilateral CIs from the Swedish health system perspective. A treatment pathway was developed through consultation with clinical experts to estimate resource use and costs. Unit costs were derived from the Swedish National Board of Health and Welfare and the Swedish Association of Local Authorities and Regions. Health outcomes were reported in terms of Quality Adjusted Life Years (QALYs).ResultsUnilateral CIs for Swedish adults with severe to profound hearing loss are likely to be deemed cost-effective when compared to a hearing aid (SEK 140,474 per QALY gained). The results were most sensitive to the age when patients are implanted with a CI and the proportion of patients eligible for CIs after triage.ConclusionsAn increase in the prevalence of Swedish adults with severe to profound hearing loss is expected as the population ages. Earlier implantation of unilateral CIs improves the cost-effectiveness among people eligible for CIs. Unilateral CIs are an efficacious and cost-effective option to improve hearing and quality of life in Swedish adults with severe to profound hearing loss.

Cost Effectiveness of Cochlear Implantation in Single-Sided Deafness.

To analyze the cost effectiveness of cochlear implantation (CI) for the treatment of single-sided deafness (SSD). Cost-utility analysis in an adapted Markov model. Adults with single-sided deafness in a high-income country. Unilateral CI was compared with no intervention. Incremental cost-effectiveness ratios were compared with different cost-effectiveness thresholds ($10,000 to $150,000) for different age, sex, and cost combinations. The calculations were based on the quality-adjusted life year (QALY), national life expectancy tables, and different cost settings. The health utility values for the QALY were either directly collected from published data, or, derived from published data using a regression model of multiple utility indices (regression estimate). The regression estimate showed an increase of the health utility value from 0.62 to 0.74 for SSD patients who underwent CI. CI for SSD was cost effective for women up to 64 years ($50,000 per-QALY threshold), 80 years ($100,000 per-QALY threshold), and 86 years ($150,000 per-QALY threshold). For men, these values were 58, 77, and 84, respectively. Changing the discount rate by up to 5% further increased the cutoff ages up to 5 years. A detailed cost and age sensitivity analysis is presented and allows testing for cost effectiveness in local settings worldwide. CI is a cost-effective option to treat patients with SSD.

A narrative review of the logistic and economic feasibility of cochlear implants in lower-income countries

Objectives: Globally, less than 1% of people who could benefit from a cochlear implant have one and the problem is particularly acute in lower-income countries. Here we give a narrative review of the economic and logistic feasibility of cochlear implant programmes in lower-income countries and discuss future developments that would enable better healthcare. We review the incidence and aetiology of hearing loss in low- and middle-income countries, screening for hearing loss, implantation criteria, issues concerning imaging and surgery, and the professional expertise required. We also review the cost of cochlear implantation and ongoing costs. Findings: The cost effectiveness of cochlear implants in lower-income countries is more limited by the cost of the device than the cost of surgery, but there are also large ongoing costs that will deter many potential users. Conclusions: We conclude that the main barriers to the future uptake of cochlear implants are likely to be logistical rather than technical and cochlear implant provision should be considered as part of a wider programme to improve the health of those with hearing loss.

Beneficios económicos del implante coclear para la hipoacusia sensorineural profunda

Evaluate the cost-benefit, cost-utility, and cost-effectiveness of cochlear implantation, comparing it to the use of hearing aids in children with profound bilateral sensorineural hearing loss. The nonparametric propensity score matching method was used to carry out an economic and impact assessment of the cochlear implant and then perform cost-benefit, cost-utility, and cost-effectiveness analyses. Primary information was used, taken randomly from 100 patients: 62 who received cochlear implants (treatment group) and 38 belonging to the control group who used hearing aids to treat profound sensorineural hearing loss. An economic cost differential was found-to the advantage of the cochlear implant-of close to US$ 204,000 between the implant and the use of hearing aids over the expected life span of the patients analyzed. This amount refers to the greater expenses that hearing-aid patients will have. With this adjusted figure, the cost-benefit indicator shows that for each dollar invested to treat the cochlear-implant patient, there is a return on the investment of US$ 2.07. The cochlear implant produces economic benefits for the patient. It also produces health utilities since positive cost-utility (gain in decibels) and cost-effectiveness (gain in language discrimination) ratios were found.

UK Appraisal of Clinical and Cost-Effectiveness of Cochlear Implantation by the National Institute for Health and Clinical Excellence

NICE (National Institute for Health and Clinical Excellence) is an independent organization responsible for national guidance on promoting good health and preventing and treating ill health. As part of the process to evaluate cochlear implants (CI) in children and adults with severe to profound sensorineural hearing loss, NICE commissioned PenTAG (Peninsula Technology Assessment Group, Institute for Health Services Research, Peninsula Medical School, Universities of Exeter and Plymouth, UK) to complete a clinical and cost-effectiveness assessment. This was to be addressed by answering the questions:

National Evaluation of Support Options for Deaf and Hearing-impaired Children: Relevance to Education Services

A large study in the United Kingdom of support options for deaf and hearing-impaired children was conducted between 1998 and 2001. Findings have been reported on prevalence, demography, auditory performance, communication skills, educational achievements, and quality of life, costs including costs of compulsory education and costs incurred by families, and on the overall cost-effectiveness of cochlear implantation. These detailed reports may not be readily accessible to all those interested and this paper therefore aims to draw out and summarise the key findings from these reports. In doing so it highlights those findings which will be of particular interest to teachers of the deaf. Copyright © 2007 John Wiley & Sons, Ltd.

National evaluation of support options for deaf and hearing-impaired children: relevance to education services

A large study in the United Kingdom of support options for deaf and hearing-impaired children was conducted between 1998 and 2001. Findings have been reported on prevalence, demography, auditory performance, communication skills, educational achievements, and quality of life, costs including costs of compulsory education and costs incurred by families, and on the overall cost-effectiveness of cochlear implantation. These detailed reports may not be readily accessible to all those interested and this paper therefore aims to draw out and summarise the key findings from these reports. In doing so it highlights those findings which will be of particular interest to teachers of the deaf. Copyright © 2007 John Wiley & Sons, Ltd.

Hearing-Impaired Children in the United Kingdom, IV: Cost-Effectiveness of Pediatric Cochlear Implantation

To estimate the cost-effectiveness of pediatric cochlear implantation by conducting a cost-utility analysis from a societal perspective. In a cross-sectional survey, the parents of a representative sample of hearing-impaired children assessed the health utility of their child using a revised version of the Health Utilities Index Mark III questionnaire. Linear regression was used to estimate the gain in health utility associated with implantation while controlling for eight potentially confounding variables: average (4-frequency, unaided, preoperative) hearing level (AHL), age at onset of hearing-impairment, age, gender, number of additional disabilities, parental occupational skill level, ethnicity, and parental hearing status. The gain in health utility was accumulated to estimate the number of quality-adjusted life years (QALYs) that would be gained from implantation over 15 yr and over a child's lifetime. The incremental societal cost of implantation, calculated in euros at 2001/2 levels, was estimated by summing the incremental costs of implantation that are incurred in the health sector, in the education sector, and by the child's family. The cost-effectiveness of cochlear implantation was estimated by calculating the incremental societal cost per QALY gained and was compared with an upper limit of acceptability of 50,000 euros per QALY. The parents of 403 implanted children, and 1863 nonimplanted children, completed the health utility questionnaire. Higher health utility was associated with a more favorable AHL, an older age at onset of hearing impairment, female gender, having fewer additional disabilities, having parents with a greater occupational skill level, white ethnicity, and implantation. The gain in health utility associated with implantation was estimated to be higher for children with a worse preoperative AHL and who were implanted when younger. Over 15 yr, for a child implanted at age 6 with a preoperative loss of 115 dB, 2.23 QALYs were estimated to be gained, compared with a mean incremental societal cost of 57,359 euros, yielding a mean cost per QALY of 25,629 euros. Cost-effectiveness was more favorable: (1) when estimated over a child's lifetime rather than 15 yr, (2) for children with a worse preoperative AHL, and (3) for children who were implanted when younger. The mean cost of gaining a QALY for the children in the present sample falls within acceptable limits. The strategy of giving highest priority for implantation to children with the greatest loss of hearing, and who are younger, maximizes benefit for a given cost.

Economic analysis and cochlear implantation

This review assesses the cost effectiveness of cochlear implantation (CI) for children and adults. Two arguments are offered: (i) an appropriate approach to estimating the cost effectiveness of CI is to use cost–utility analysis to estimate the cost of gaining a time-integrated unit of quality of life, expressed as a quality-adjusted life year (QALY). (ii) The Mark III Health Utilities Index is an appropriate self-report instrument for assessing the gain in quality of life associated with CI, provided that “quality of life” is interpreted as a measure of society's usual preference for better hearing rather than as an indication that impaired hearing equates to poor health. Cost–utility analysis shows that, for most groups of candidates, unilateral CI gains a QALY for significantly less than the value of €50,000 that has been inferred to define the upper limit of acceptability for the National Health Service in the United Kingdom (UK). Cost–utility ratios estimated for bilateral CI fall significantly above this limit, but could be acceptable in some countries that devote a higher percentage of their Gross Domestic Product to health care than the UK does at present.

A model of educational resource use by children with cochlear implants

We have tracked patterns of use of educational and rehabilitative resources as part of an initial assessment of cost-benefit ratios of cochlear implants in children. Forty-two children with cochlear implants in the Listening Center at Johns Hopkins program of aural rehabilitation have served as our study cohort to develop the measures to be assessed. An educational resource matrix stratifies school setting (residential vs special education vs nonspecialized “mainstream” setting) and levels of rehabilitative support (speech and language therapy and interpreter use) to map past and current use of these services. Initial cost-benefit projections based on observed advancement toward educational independence in the educational resource matrix indicate an extremely favorable net present value of the implant (cost savings minus cost). These cost-benefit projections will need to be supplemented with measures of the impact on quality of life and future educational and vocational options to determine the overall cost-effectiveness of cochlear implants in children. (Otolaryngol Head Neck Surg 1997;117:174-9.)